Rotator cuff tears and tendinopathy
29th February 2024 - By Ali McGill
Managing the painful shoulder
The shoulder joint (also known as the glenohumeral joint or GHJ) is surrounded and supported by a powerful band of muscle tendons called the rotator cuff. The rotator cuff muscles of the shoulder work as a dynamic structure to centralise the head of the humerus (upper arm bone) in the socket (made by the shoulder blade or scapula) and aid movement, acting to keep the GHJ functioning and stable.
Structural changes in muscle tendons:
Type 1 collagen is the most abundant connective tissue in tendons, but these can degenerate over time, in response to injury or due to metabolic conditions (such as diabetes). This phenomenon is termed “tendinopathy, and this process can affect a tendon’s:
tensile strength ie. the ability to transmit force from muscle to joint
shock absorption
innervation and blood supply, leading to a potential increase in sensitivity and increased risk of tears
MRI and ultrasound are the preferred imaging modalities for imaging and evaluating tendon tears. Important to note however, is that tendon abnormality seen on imaging does not always diagnose the cause of your pain, as many people with asymptomatic pain-free shoulders demonstrate rotator cuff tears or tendon abnormality on imaging. In adults over the age of 60, 66% of rotator cuff tears found on imaging are asymptomatic. The use of routine scanning for cuff tears therefore remains debated in terms of efficiency. Your physiotherapist can refer you for necessary imaging as they see fit to assist in the diagnosis and management plan for your painful shoulder condition.
Management of rotator cuff tendinopathy
The two treatment pathways for rotator cuff tendinopathy are; Non operative management such as lifestyle changes, physiotherapy and injections or shockwave therapy; and operative management, which consists of a subacromial decompression surgery to increase the available anatomical space for the tendons to pass through.
Management of rotator cuff tears
In the case of an acute rotator cuff tear, urgent referral to a specialist surgeon is advised to discuss the potential for surgical management and repair. Indications that support surgical tendon repair are:
High energy traumatic injuries
People in high performing roles that require shoulder use for their sport or hobby
People under 50
In the case of non-traumatic tears: where non-operative management including physiotherapy for >3 months has failed and patient has persistent pain and dysfunction